Reply to NSF's Proposal for Some Changes/Improvements in SAF
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original post here http://sgforums.com/forums/1390/topics/451013
I was an ex-MO in the SAF. Coming from having served some of the busiest medical centres in singapore, i believe this puts me in an adequate position to enlighten forumers here on some issues in the SAF medical system.
Firstly, medical officers in SAF have two roles:
1) As commissioned officers in the SAF
2) As doctors in the SAF
We take the health of our servicemen seriously. Having served MOCC training, we take many gruelling medical courses and recertification of our Advanced Cardiac Life Support course and also go on to take the Advanced Trauma Life Support course which are both validated protocols/courses in the west dictating high standards of care in resuscitation and emergency/disaster care.
Our medical centres, no doubt having few medicines compared to the hospitals or GP clinics you see in our local civilian context, is at least equipped medications to treat most common ailments and each and every medical centre, i guarantee, has the essential equipment and drugs for resuscitation.
Cases like Private Lee are indeed unfortunate. There is indeed a chance that he has fallen through the loopholes. Having served as an MO, and in fact, even being involved as a doctor in care for a servicemen who passed away, i can say for sure that there is REALLY alot of effort put in to prevent repeat episodes, and extensive inquiry is actually carried out. SAF medical directives are constantly revised in view of these incidents, and similarly they are constantly revised so that they reflect the latest standard in medical care.
SAF also has tie ups with various specialist/tertiary care centres in singapore, leading to shorter waiting time and access to tertiary facilities like advanced cardiac investigations in National Heart Centre SGH.
All in all, with our dual roles in SAF, I can safely represent my fellow medical colleagues in saying that first, we treat each and every servicemen as patients first, then as SAF personnel.
This leads me to my next issue. SAF has a duty to maintain its ops readiness, this includes sufficient manpower and equipment for manning of its defence capabilities, ample training of its servicemen (exercises, operations etc). This being said, we doctors have a duty to ensure that while servicemen's illnesses and health are being taken care of, we also have a duty as commissioned officers that our men are trained well and of course safely. This is why downgrading has to be strictly by-the-book following directives to ensure that our men are properly placed in vocations suitable with whatever disability or illness they may have.
Lastly, i will touch a bit on malingering. Based on personal experience as both a doctor in civilian practice and having served as an MO, i can say that there are indeed a good many malingering cases. I shall classify them as follows:
1) Frank malingerers
2) Opportunistic malingerers
In my opinion, opportunistic malingerers are actually a normal phenomenon - i.e. they are not true malingerers. Let me illustrate with a case to show what i mean. Servicemen XX comes to medical centre complaining of knee pain, there is evidence from examination validating the symptom experienced, but definitely not as severe to warrant too prolong a rest duration or strong medications. Servicemen XX then continues to request MC for rest. This is a case of opportunistic malingering, however it is normal, because these are patients who are into the "sick role" mode, aka patient mode, and hence need rest to recover. While i do nag at them at times, i definitely do not charge these ppl to DB and definitely allow them some rest duration in the form of light duties.
Frank malingerers are those who fake their MCs from external sources, fake specialist letters etc so that they can find an excuse to be downgraded. There is a clear case of secondary gain from these ppl. i.e these ppl come in requesting for privileges like excuse stay-in, changing vocations etc. I have personally charged quite a few of them.
As an SAF doctor/officer i have both the duty to make sure my men are adequately treated and at the same time, serve also as a safeguard and deterrent so that servicemen do not take it as an opportunity to malinger. With my illustration above, you can see why it is important. Imagine a battalion has about 700 ppl. If just 10 percent reports sick, that is already 70 ppl. Imagine if we are lax with MCs, and allow senseless downgrading, the battalion will be down to just 10 people in 2 months.
On a personal note, i'd say - NS is only two years. What really is so difficult and so physically tough? Any of us, if we ask our parents, will clearly note that in the past, training was definitely tougher. Today's servicemen have alot more conditioning and preparation and health screening compared to servicemen of the past.
Take it as a chance to boost up your physique, to lose weight, to make yourself a healthier person. Go into NS/BMT/XX camp for whatever vocation with an open mind, not with a mind to siam training, not with a motive to get downgraded etc and you'll find that the experience is actually not so bad.
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There is no doubt that PTE Lee's death is due to the negligence of SAF. It is common knowledge that smoke and haze can triggered an acute asthma attack.
- So, people who have asthma or chance of getting an asthma attack should never be posted to an active frontline role.
- The MOP has never allowed the carry of a venolin inhaler. The medic on cover cannot adminster an inhaler for an asthmatic patient. He may carry an oxygen tank during peace, but the 02 tank is not there for outfield exercise.
- Venolin is a drug and can only be adminstered by a doctor.
- The patient will have to carry the inhaler himself. But, when he is running, how do he know if he is tired and panting or having an asthma attack? When he is already unconsicous, how can he admister the venolin himself?
- In some cases, the asthma patient may be even allergic to inhaler itself (including me).
- In the early days of NS, obese, flat-footed, gay and asthma patients are automatically clerks. SAF bent the rules later. These are the results. These cases are never there in the past because these patients are never enlisted as combat-fit soldier.
So I would encourage the pre-enlistees, NSFs, NSman to declare their medical conditions carefully.
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I will not be too quick to say that it is negligence. 4 questions remain unanswered
1) Did PTE Lee declared that he has active asthma during any medical screening done by the SAF?
2) Did he bring his inhaler? Or Inhalers?
3) Was he cleared for fitness for the training?
4) Do commanders know that he actually has asthma?
Asthma is a chronic restrictive airway condition. That does not mean you cannot exercise. There are directives dictating control of asthma and their respective PES gradings if i never remember wrongly.
Medics can administer ventolin inhaler. For your info, it is a key item in EVERY medic bag.
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mmm..
Reminds me of hearing of someone who has skin eczema having to go through the gas chamber exercise...
The reply heard of is because it's only go thru the exercise to know whether are you really sensitive to it or not...
From what I understand, ever since then the guy has to apply a stronger steroid cream on his day to day use.
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Originally posted by Hiwatari:
I will not be too quick to say that it is negligence. 4 questions remain unanswered
1) Did PTE Lee declared that he has active asthma during any medical screening done by the SAF?
2) Did he bring his inhaler? Or Inhalers?
3) Was he cleared for fitness for the training?
4) Do commanders know that he actually has asthma?
Asthma is a chronic restrictive airway condition. That does not mean you cannot exercise. There are directives dictating control of asthma and their respective PES gradings if i never remember wrongly.
Medics can administer ventolin inhaler. For your info, it is a key item in EVERY medic bag.
I agree. The boy may want to act strong and fail to report.
Perhaps, they have changed the MOP items. OR the inhalers are extra. Under the official list, it should contain 2 hartmann sets, 10 casualites cards, 2 crepe bandages and more (there are panadols). The BCS bags, MO box, ops stores do have inhalers. I ORD like 10 years ago. This may have changed.
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Originally posted by sbst275:
mmm..
Reminds me of hearing of someone who has skin eczema having to go through the gas chamber exercise...
The reply heard of is because it's only go thru the exercise to know whether are you really sensitive to it or not...
From what I understand, ever since then the guy has to apply a stronger steroid cream on his day to day use.
I was excused for gas chamber exercise due to allergy rhinitis.
In the first place, the guy should never mop up due to skin eczema.It is the clothing that is giving him the problem not the gas.
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Those who do not serve front-line units will always argue for less time spent "rushing to wait".
Unfortunately, for those who do serve in front-line units, even 22 months can be considered a tad short.
My own experience was that it took me a year from enlistment before I was allowed to execute normal duties. And it took me a few more months to be proficient and confident in my stuff. By then I could already start looking forward to ORD.
BTW.
By "front-line" I was not really talking about those who chiong into the battle-field first in war. I was referring to day-to-day ops. Think about those who keep you guys safe as you sleep. You might think its nonsense. But that in itself is testimony to the vigilance of the less visible servicemen.
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Originally posted by Hiwatari:
Lastly, i will touch a bit on malingering. Based on personal experience as both a doctor in civilian practice and having served as an MO, i can say that there are indeed a good many malingering cases. I shall classify them as follows:
1) Frank malingerers
2) Opportunistic malingerers
In my opinion, opportunistic malingerers are actually a normal phenomenon - i.e. they are not true malingerers. Let me illustrate with a case to show what i mean. Servicemen XX comes to medical centre complaining of knee pain, there is evidence from examination validating the symptom experienced, but definitely not as severe to warrant too prolong a rest duration or strong medications. Servicemen XX then continues to request MC for rest. This is a case of opportunistic malingering, however it is normal, because these are patients who are into the "sick role" mode, aka patient mode, and hence need rest to recover. While i do nag at them at times, i definitely do not charge these ppl to DB and definitely allow them some rest duration in the form of light duties.
Frank malingerers are those who fake their MCs from external sources, fake specialist letters etc so that they can find an excuse to be downgraded. There is a clear case of secondary gain from these ppl. i.e these ppl come in requesting for privileges like excuse stay-in, changing vocations etc. I have personally charged quite a few of them.
As an SAF doctor/officer i have both the duty to make sure my men are adequately treated and at the same time, serve also as a safeguard and deterrent so that servicemen do not take it as an opportunity to malinger. With my illustration above, you can see why it is important. Imagine a battalion has about 700 ppl. If just 10 percent reports sick, that is already 70 ppl. Imagine if we are lax with MCs, and allow senseless downgrading, the battalion will be down to just 10 people in 2 months.
Take it as a chance to boost up your physique, to lose weight, to make yourself a healthier person. Go into NS/BMT/XX camp for whatever vocation with an open mind, not with a mind to siam training, not with a motive to get downgraded etc and you'll find that the experience is actually not so bad.
On the issue of "malingering", I can see two concerns.
The first is units do not observe the "light duty" status. How many of us have been given "light duty" by SAF MOs only to practically perform our normal duties? The problem stems from regular commmanders dismissive attitude towards the need for rest and recuperation from injuries to prevent long term damage and loss of performance. It is senseless, but then again it is not their body at risk.
The second comes from MOs perceiving a lack of power and discretion to prescribe short term or long term status. This is not an attack on MOs who fall under the usual military command structure. The most common form of this problem, comes from there being no means to confirm or dismiss a condition or injury. In the civilian world, think of what happens when you touch the bumper of a taxi and the driver goes to his doctor. The doctor says he cannot definitely confirm or dismiss the existence of muscle pain and therefore the court awards some middle point of damages. In the military world, the attitude is reversed and MOs will often tell you their hands are tied. This shows it is not completely their fault. However, different MO's perception of discretion leads to inconsistency in MC or downgrading for the same medical conditions.
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how come australia they got people who fail secondary school twice and still can end up as fighter pilot?and then tyhey can get 3 degrees and a masters degree too!
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I was an ex-MO in the SAF. Coming from having served some of the busiest medical centres in singapore,
During my time, when Officers talk, we listen and obey.
Maybe time really fly.......
Thinking soldiers???
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Originally posted by Onewaytransfer:
I was an ex-MO in the SAF. Coming from having served some of the busiest medical centres in singapore,
During my time, when Officers talk, we listen and obey.
Maybe time really fly.......
Thinking soldiers???
There's a saying too many cooks spoil the soup.....
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SAF can always have how good hardware.. but if the software is bo chup attitude then the whole place will eventually rot...
Being most educated dosen't mean anything either.
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Originally posted by tarutaru:
There's a saying too many cooks spoil the soup.....
Last time Officers say "charge", all chiong like nobody business.
Now? Soldiers will ask you back "Why Ah?"
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experience counts
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Ultimately, it is still your own responsibility to take good care of your body.
Enough said.